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UroToday.com - Magnetic resonance imaging (MRI) is beginning to play a major role in pediatric urology. Current work done by Damien Grattan-Smith and colleagues are assessing renal function based on MRI imaging giving both a functional and crisp anatomical study especially when implementing 3-D reconstruction. Although typically implemented for the urinary tract, this study by Terai et al retrospectively correlated the MRI diagnosis with the surgical findings and/or clinical outcomes in patients presenting with an acute scrotum. From January 1997 to June 2004, 39 selected patients presented with an acute scrotum and underwent dynamic contrast-enhanced subtraction MRI study. The MRI diagnosis was based solely on the presence or absence of testicular contrast enhancement, without respect to the clinical history or presenting physical examination findings. The group found that contrast enhancement of the affected and normal testes could be accurately compared in all cases. The MRI diagnosis was testicular torsion (no testicular contrast enhancement, n = 13), nonspecific (reduced to normal enhancement, n = 10), appendiceal torsion (n = 3), and epididymitis (n = 13). The surgical findings and/or subsequent clinical outcomes showed that MRI diagnosis of testicular torsion was accurate in all 13 cases. Furthermore, exploration revealed testicular torsion in 1 case with very little enhancement. The sensitivity and specificity of MRI in the diagnosis of testicular torsion was 93% (13 of 14) and 100% (25 of 25), respectively. Although MRI detected testicular perfusion, 5 of the 6 patients with clinical suspicion of intermittent torsion underwent surgical exploration. The group concluded that MRI is a highly accurate imaging modality for the diagnosis of testicular torsion. However, it could not be used to rule out intermittent torsion and the clinical use of negative findings for an MRI torsion test was less than 100% specificity. They stated that because this was a preliminary retrospective study, the true clinical value of MRI should be evaluated by prospective studies. It seems that even with such precision achieved by MRI, the clinical decision to operate would over ride the study. Although technically fancy and pushing the limits of radiologic intervention, I would be concerned of delay in treatment since we all are aware that time is of the essence. What ever happened to clinical judgment and a knife? Akito Terai, Koji Yoshimura, Kentaro Ichioka, Nobufumi Ueda, Noriaki Utsunomiya, Naoki Kohei, Yoichi Arai and Yuji Watanabe UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
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